Is there a role of preservation of the spleen in distal pancreatectomy?

• Published in: Journal of the American College of Surgeons Vol. 188; no. 3; pp. 255 - 260
• Main Authors: Benoist, Stéphane, Dugué, Laurent, Sauvanet, Alain, Valverde, Alain, Mauvais, Francois, Paye, Francois, Farges, Olivier, Belghiti, Jacques
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-03-1999; Elsevier Science; American College of Surgeons
• Subjects: Adult; Aged; Biological and medical sciences; Female; Humans; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Pancreatectomy - adverse effects; Pancreatectomy - methods; Pancreatic Diseases - surgery; Retrospective Studies; Spleen - surgery; Splenectomy - adverse effects; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; Human; Postoperative; Spleen; Conservation; Pancreatectomy; Morbidity; Splenectomy; Surgery; Distal; Digestive diseases; Adult; Benign neoplasm; Pancreas; Comparative study; Pancreatic disease
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/S1072-7515(98)00299-3

Background: The spleen may be preserved during distal pancreatectomy (DP) for benign disease. The aim of this retrospective study was to compare the postoperative course of DP with or without splenectomy.
Study Design: From June 1992 to June 1997, 40 adult patients without chronic pancreatitis underwent elective DP for benign lesions. Fifteen underwent spleen-preserving DP (Conservative Group) and 25 DP with splenectomy (Splenectomy Group). In spleen-preserving DP, we attempted to preserve the splenic artery and vein.
Results: Spleen-preserving DP was successfully performed in all 15 cases. Patient groups were comparable for clinical features, indication for DP, and surgical procedure. There were no postoperative deaths. The overall incidence of pancreatic fistula was 23%, but was significantly higher in the Conservative Group (40%) than in the Splenectomy Group (12%; p < 0.05). Subphrenic abscesses were more frequently observed in the Conservative Group than in the Splenectomy Group (p < 0.05). The mean duration of postoperative hospital stay was 19 days (range 6 to 46 days) in the Conservative Group and 12.5 days (range 7 to 45 days) in the Splenectomy Group (p < 0.05). At the end of mean followup of 30 months (range 8 to 40 months), no severe postsplenectomy sepsis was observed in the Splenectomy Group.
Conclusions: In our experience, DP with splenectomy has a lower morbidity rate and we consider it to be the best procedure for benign pancreatic disease.